Exam #1 Flashcards
(183 cards)
1
Q
Pathology - def.
A
- the science of the causes and effects of diseases
- the branch of medicine that deals with the laboratory examination of samples of body tissue for diagnostic or forensic purposes
2
Q
Sports medicine - def.
A
- also known as sport and exercise medicine
- branch of medicine that deals with physical fitness and the treatment and prevention of injuries related to sports end
- heavy focus on MSK system
3
Q
What does sports medicine include as its focus?
A
- injury prevention
- injury assessment, recognition, and diagnosis
- treatment and rehab
- performance enhancement - training, nutrition, psychology
- management of medical issues
- exercise prescription in health and chronic diseases
- medical care of sports teams and events
- environmental issues (ex altitude)
- ethical issues (ex anti doping)
- special populations
4
Q
what is the main role of athletic therapy in sports medicine?
A
“rapid return to work and play”
5
Q
what are the two components of treatment and rehab?
A
1) treat the presenting problem
2) treat the cause of the problem
-individualized care
6
Q
the sports medicine model
A
- interdisciplinary field encompassing:
- athletic therapists, massage therapists, strength and conditioning coach, psychologist, dietitian, physician, etc.
7
Q
name three sports medicine organizations
A
1) CATA
2) MATA
3) NATA
4) CASM
5) manitoba college of dietitians
6) canadian sport psychology association
7) manitoba physiotherapist association
8
Q
what are the 4 steps that make up the sequence for prevention of sports injuries?
A
1) establish the extent of the injury
- incidence
- severity
2) establish the etiology and mechanisms of the injury
- common injuries present in different sports
3) introduce a preventive measure
4) assess its effectiveness by repeating step 1
9
Q
the prevention of athletic injuries is achieved through what?
A
primary, secondary, and tertiary prevention
10
Q
what is primary prevention?
A
1) the promotion of health
- i.e. PA, medical screening and movement analysis
2) injury prevention
- i.e. knee or ankle braces, protective equipment, conditioning, training techniques, facility and equipment surveys, rules and regulations
11
Q
what is secondary prevention?
A
1) early diagnosis
- i.e. medical and orthopedic assessment, imaging
- getting athletes to come see you before they start getting aches and pains
2) early treatment intervention
- i.e. RICES
- rest, ice, compress, elevate, stabilize
12
Q
what is tertiary prevention?
A
- rehabilitation
- i.e. manual therapy techniques, therapeutic exercise, and RTP (return to play) protocols
13
Q
what are 7 internal risk factors for injury?
A
1) age
2) gender
3) body composition (e.g. body weight, fat mass, BMI, anthropometry)
4) health (e.g. history or previous injury, joint instability)
5) physical fitness (e.g. muscular strength/power, VO2max, joint ROM)
6) anatomy (e.g. alignment, intercondylar notch width)
7) skill level (sport specific technique, postural stability)
14
Q
what is the pre-participation physical evaluation (PPE)? what is its purpose?
A
-test to screen athletes to see if they’re at risk for certain injuries
Purpose:
1) determine general health
2) rule out disease or predisposing orthopedic and systemic conditions
3) establish baselines
15
Q
when should a PPE be completed?
A
prior to any athletic participation; by athlete’s family physician/team physician
16
Q
what does the literature say about the usefulness of the PPE?
A
does not support that a PPE will predict who will develop MSK injuries
-but it’s a good way to screen and highlight a few things
17
Q
what are the objectives of the PPE?
A
provides considerable information that is relevant, practical, and beneficial for the athlete in optimizing both their sport performance and overall health
18
Q
when documenting information on past illnesses, conditions, and/or injuries, what should you include?
A
1) respiratory problems
- asthma, fainting
2) cardiac problems
- irregular heart beats, murmurs, sudden death in family (SCD/HCM)
- especially important in older populations
- strenuous activities, informing people to pace themselves, defibrillator on hand, emergency action plan in place
3) prior concussions/head injuries
- can cause neurological damage
4) prior neck injury
- burners, 3’s
5) prior extremity injuries
- #’s sprains, strains, contusions
6) any hospitalization or surgeries
19
Q
what type of consent is needed in order to be able to share a patient’s medical information? Are there exceptions to this rule?
A
- need written permission to share medical or injury information with a specified individual or group of individuals
- this MUST be signed prior to releasing an individual’s medical info (PHIA and FIPPA)
- there are exceptions in the case where information must be shared with a physician or when the person is unconscious
20
Q
why are injury report forms important?
A
- in case of law suits
- for the sake of remembering what happened
- can aid in the injury diagnosis
21
Q
Prevention: what should you be looking for when conducting a facility survey?
A
1) indoor FOP conditions
- lay of the playing surface
- proper ventilation and lighting
- visibility and accessibility of exits
- cleanliness and proper maintenance
- presence of a safety zone beyond court boundaries
2) outdoor FOP conditions
- gopher holes, divots, lay of the surface
- cleanliness and proper maintenance
- presence of a safety zone
3) presence of dangerous obstacles
- sport equipment is safely stored and or secured
- presence of hazards left unprotected
- underground sprinklers, benches, goal posts, or standards, debris sport equipment, etc.
22
Q
Prevention: what should you be looking for when conducting an equipment survey?
A
1) is equipment in safe operating condition
- i.e. no frayed cables or ropes, missing springs, broken or projecting parts, cracks, rusted bolts/clips, etc.
2) adherence to info provided on warning labels regarding instructions on appropriate/recommended use
23
Q
what do you do with equipment/facility survey results?
A
- when hazards are identified, ensure you record the problems and submit report to your immediate supervisor
- ensure that the hazards identified are repaired before future use
- do not use defective or unsafe equipment - remove until repaired
24
Q
what are the 3 main purposes of protective equipment?
A
1) prevent injury
- help reduce the severity of injuries, but not 100% effective
2) prevent re-injury
- can also be utilized to RTP an athlete after an injury
3) improve performance
- designed in such a way as to not interfere with movement and/or the sporting activity
25
what are the 5 ways in which we can ensure our equipment works properly?
1) effectively protects the body part it is DESIGNED for
2) must provide a good fit
- appropriate for the athlete
3) allows for good heat exchange
- when equipment is covering a large portion of the body
4) maintained and repaired often
5) kept clean
26
the effect of a physical impact is dependent on which 3 things?
1) magnitude of the force
2) duration of the force
3) area of the body it is applied to
27
protective equipment protects by which 4 mechanisms?
1) absorbing the force
- decreasing the magnitude and increasing the duration of impact
- padding or foam
- ex: hockey helmet
2) deflect forces
- decreasing duration of impact
- ex: cup
3) dissipating forces
- over larger and stronger areas using a cantilever system
- ex: shoulder pads
4) restricting abnormal joint movement
- ex: ankle brace
28
protective equipment should incorporate which 5 things?
1) an absorptive phase between impact and rebound
- some kind of padding or foam, varying in thickness and density depending on the sport
2) distribute impact to larger and stronger areas
- proper size and fit
3) not endanger an opponent
- ex: metal cleats in soccer
4) not be affected by temperature changes
5) not cause excessive heat build up
29
what are the 6 factors that should be considered upon purchasing equipment?
1) sport and hazard
2) age group
3) mobility required
4) ease and cost of maintenance
5) quality and workmanship (CSA, NOCSAE)
6) price
30
when wearing protective equipment, there is always a trade off between ______ and ______
mobility, protection
31
what must manufacturers include on ALL their pieces of equipment being sold?
- must forsee all possible uses and misuses
| - must warn all users of any potential risks inherent with use or misuse or product
32
how can we decrease liability when buying/wearing protective equipment?
1) buy equipment from reputable manufacturers (i.e. CSA, NOCSAE)
2) assemble according to guidelines - "to the letter"
- need to make sure you aren't altering anything about the way equipment is supposed to be used
3) routinely inspect and replace/repair
4) regular and proper maintenance
5) use caution when customizing
6) DO NOT use defective equipment
33
what is "preventative conditioning"?
- it is important to have the necessary strength, flexibility, etc. to do the activity you're doing
- need to know how to do things safely
- risk of injury is related to fitness level
34
during which periods do the majority of injuries occur?
1) during training camp
- just getting back into a sport, may not have done as much off season training as you were supposed to, not ready for sport demands
2) during first 1/3 of season
- coaches like to go hard, get back into shape, expect players to be ready
3) last 1/3 of the season
- people get tired/lazy - long seasons
- pushing towards the playoffs, working harder
35
what is the relationship between injury rates and whether someone is winning or losing a game?
- people tend to get more injured when they're losing
- take more risks
- motivation is also down, may not be doing everything as they should
36
what should be the main focus in order to decrease risk of injury throughout a season?
preventative strategies should focus on pre season conditioning followed by a maintenance program throughout the season and into the post season
37
periodization - def.
an approach that attempts to bring about peak performance while decreasing injuries and over training
- different needs at different points in the season
- organizes program of training into cycles or periods
38
periodization: macrocycle
- whole training period
- can be a year, season, 4 year plan, etc.
- different for each person
39
periodization: mesocycle
- 2-3 weeks or month within the macrocycle
- preparatory, competition, transition period
- cross training (various sports to learn different movement patterns)
40
what are the 10 principles of conditioning?
1) safety - i.e. proper protocol
2) warm up/cool down
3) motivation
4) overload - SAID principle (specific adaptations to imposed demands)
- making sure you're exposed to proper stresses, want to overload without causing damage
5) consistency
6) progression
7) intensity
8) specificity
9) individuality
10) minimal stress
- don't want to stress too much, also a mental aspect
41
which three things must we take into consideration when executing a pre season conditioning program?
1) nature of the sport or activity
- strength, endurance, contact, non-contact, explosive (plyometrics), etc.
2) areas of predominant stress
- shoulders, knees, elbow
3) predominant fitness components
- muscular endurance, CV endurance, strength, agility, flexibility
42
ALL pre-season conditioning must include which 6 aspects?
1) CV endurance - FITT principle
- frequency (3-5 days per week, intensity (HR), type (sport specific, cross training)
2) strength training
3) muscular endurance
4) flexibility
5) sport related skills
6) skill development
43
how does in-season conditioning differ from pre-season conditioning?
1) is utilized to avoid de-conditioning
- maintenance
2) every in-season program involves: 1-2 sessions per week at 80% max and includes all fitness components of the pre-season program
3) training at this level will suffice to athlete's fitness level
44
post-season conditioning
- commonly dedicated to restoration
- time to unwind and recover from the season and recuperate from injuries
- means "active rest" - not being a couch potato
- also a time for surgery and subsequent rehab from injuries sustained during the season
45
liability - def.
being legally responsible for the harm one causes another person
46
what do we mean when we talk about th e"good samaritan law"
only perform skills within your scope of practice
47
what are the two courses that can be taken by legal action? explain them
1) criminal suit: deals with serious offenses
- i.e. robberies, assaults, murders
2) civil suit: deals with non-premeditated offenses
- most common litigation in sport
48
negligence - def.
not providing reasonable or ordinary care
49
tort - def
a legal wrong
50
nonfeasance (act of omission) - def
failure to perform a specific legal duty
| -ex: not calling for advanced help in a life threatening situation
51
malfeasance (act of commission) - def
commit an act that is not legally yours to perform
| -ex: cutting someone open
52
misfeasance - def
improperly doing something that you have the legal right to do
-ex: transporting someone with a spinal
53
foreseeability - def.
condition whereby danger is apparent or should have been apparent, results in unreasonable, unsafe conditions
-facility management
54
there are 4 things used to establish negligence, what are they?
1) a duty of care existed between the person injured and the person responsible for the injury
- ex: random person off the street can't sue you
2) the defendant breached this duty by conduct that fell short of the standard of care
3) the defendant caused the injury to occur
4) personal, property, or punitive damages resulted
55
what are the 6 ways in which we can avoid litigation?
1) warn individuals of potential hazards of the sport
2) supervise regularly and attentively
3) properly prepare and condition athletes/participants
4) properly instruct individuals in the skills of their sport (progressions)
5) utilize proper and safe equipment
6) never delay in seeking medical assistance or compel a person to participate against their wishes
- i.e. never advise a person to play injured
56
what are the 6 ways in which individuals can reduce liability?
1) maintain strong relationships with athletes, parents, coaches
2) establish policies and procedures
3) establish/practice emergency action plans
4) obtain and review current medical history of athletes
5) documentation of injuries and safety surveys of facilities and or equipment
6) obtain sufficient liability insurance
57
what are some defenses that can be used against negligent actions?
1) pure accident
2) assumption of risk (reasonable based on age, experience, warning signs, waivers, inquiries as to physical fitness)
3) contributory negligence: failure to act as instructed or reasonable
4) not directly or indirectly related to circumstances in instructor's control
5) acts of god
58
what is explicit consent?
- consent given by injured individual when they agree to 1st aid - "can I help you?"
- can be withdrawn at any time
59
what is implied consent?
- consent whereby the individual is not capable of giving explicit consent but needs it regardless
- an emergency - used to save a life
60
what are the components of a non urgent MSK assessment?
1) rule out life threats (primary survey)
2) rule out spinal injuries (primary)
3) assess vitals
4) HOPS assessment - history, observation, palpation, special tests
5) immediate treatment/management
6) safe removal from FOP
7) sideline assessment and management
8) document injury evaluation
61
to establish that any given situation is non urgent, you first need to rule out what?
the presence of a life threatening injuries and or illnesses
62
primary survey - components
1) assess level of consciousness (LOC)
- AVPU scale
- if athlete is unconscious call 911
2) assess CAB (circulation, airway, breathing)
- 10 second breathing and pulse check
- begin CPR or rescue breathing as needed
- obtain an AED
3) check for profuse bleeding
- body scan
- use of gloves for protection
4) shock
- common with severe bleeding, fractures or internal injuries
- pre-disposing conditions (extreme fatigue, extreme exposure to heat/cold, extreme dehydration and mineral loss, illness)
63
how do we know which vessels blood is coming from?
- arterial blood is bright red, and comes out in spurts
- venous blood is dark red, and comes out as a continuous flow
- capillary blood blood exudes from tissue
64
what are the treatment methods for profuse bleeding?
- Primary method: direct pressure and elevation
| - Secondary method: pressure points (brachial or femoral artery)
65
what are the three different types of shock?
1) hypovolemic: stems from blood loss
2) anaphylactic: results of severe allergic reaction
3) pyschogenic: fainting (syncope), temporary reduction in blood to brain
66
what are the signs and symptoms of shock?
1) slow, shallow breathing - rapid or panting initially
2) confused or disoriented
3) decreased LOC - listless
4) dilated pupils
5) restlessness or irritability
6) rapid but weak irregular pulse
7) pale, cool and moist skin
8) nauseous or vomiting
9) drop in blood pressure
67
explain the process of ruling out a spinal injury
1) unconscious patient (especially if MOI un-witnessed)
- assume possible neck and cervical spine injury
2) conscious patient
- ask about neck/back pain, numbness, and tingling in extremities
- ask to wiggle fingers/toes (motor)
- ask if they can feel your touch (sensory)
- palpate neck/back looking for obvious signs of injury (i.e. crepitus and deformities, muscular spasm)
3) suspected spinal injury
- do not remove patient
- call 911
- maintain proper stabilization of the head and neck
- help patient maintain normal breathing (vitals)
- treat any profuse bleeding or shock
- keep patient quiet and calm
68
what are the three primary vital signs?
1) pulse
2) respiration
3) blood pressure
69
assessing vital is part of the first or secondary survey?
secondary
70
what are the 9 vital signs
1) LOC
2) pulse
3) respiration
4) bp
5) temperature
6) skin colour
7) pupils
8) movement
9) abnormal nerve response
71
how can we measure pulse? what can pulse tell us?
- measured with carotid artery in neck or radial artery in wrist
- normal pulse (adult) = 60-100 bpm - athletes are normally lower
- Rapid and weak pulse - shock, bleeding, diabetic coma or heat exhaustion
- Rapid and strong pulse - heatstroke or severe fright
- Strong and slow pulse 0 stroke or skull fracture
- No pulse - cardiac arrest or death
72
how can we assess breathing? what is considered a normal breathing rate?
- look for movement of chest
- listen for air passing in and out of the nose and mouth
- feel chest (supine) or back (prone) rise and fall
- normal breathing rate (adult) = 12-20 breaths/minute
- may be increased or decrease by athletic participation
- can be altered due to chock (shallow) or rib fracture (frothy blood coughed up)
73
systolic blood pressure
left ventricle contracts (pumping blood)
74
diastolic bp
residual pressure in arteries between heart beats
75
what is a normal blood pressure?
120 (systolic) / 80 (diastolic)
76
what would a low bp indicate? (hypotension)
may indicate hemorrhage, chock, heart attack, or internal organ injury
77
what would a high bp indicate? (hypertension)
increased risk of heart attack or stroke, may be linked to kidney disease
78
is the HOPS assessment part of the primary or secondary survey?
secondary
79
what is the HOPS assessment? (H)
History
- obtain information about the injury
- main complaint
- ask SAMPLE (symptoms, allergies, medication, past history, last oral intake) and PQRST (provocation, quality (of pain), region, severity, time)
- MOI, other sensations, sounds, prior injuries, etc.
80
what is the HOPS assessment? (O and P)
Observation and palpation
- visual and light palpation looking of any of the following:
- DCAP BLS TIC - deformity, contusions, abrasions, paradoxical movement or penetrations, bruising, lacerations, swelling, tenderness, instabilities, crepitus
- SHARP - signs of inflammation (swelling, heat, altered function, redness, pain)
81
what is the HOPS assessment? (S)
Special tests
- provide information for immediate treatment/management
- AROM/willingness to move
- Fracture tests: tap, compression, squeeze, bump, tuning fork
82
MSK assessment components: immediate treatment/management
Any suspected fracture or dislocations are treated on the FOP prior to moving patient
- especially lower limb
- upper limb may be moved and managed on the sideline
Guidelines for proper splinting
- address any open wound or bleeding first
- splint in the position in which it is found
- make sure splint immobilizes the injury (no movement)
- immobilize the joint above and below the injury site
83
MSK assessment: safe removal from FOP
-utilize various transportation techniques and or equipment
Medical equipment:
- spine board
- stretcher/gurney
- rescue vehicles
Transportation techniques
-assisted ambulation (1-person or 2-person human crutch, cross arm carry)
84
what are the progressions or movement sequences for removal from FOP
- supine to prone
- prone to all fours
- all fours to sitting up on knee
- on knees to one knee
- one knee to standing
85
what is the acronym used to explain how to go up and down stairs with crutches?
up stairs: HIC-up
-healthy, injured, crutch
down stairs - opposite
-crutch, injured, healthy
86
MSK assessment: sideline assessment and management - what type of knowledge is required for this?
1) human anatomy
- landmarks, body planes and axes, actions and movements
2) basic biomechanics
- movement principles and considering relevant kinetic chains
3) pathology
- tissue properties, healing process, common signs and symptoms
4) understand the sport/activity
- fitness and technical demands
87
why is a sideline assessment important?
1) differential diagnosis
- need to know if the injury or condition is MSK in nature and not something else
- consider all etiologic factors
- if the history and examination do not fit the person's injury features or clinical pattern, suspect other conditions that may be more serious, explore further, refer to specialist
2) targeted optimal therapy/tx
- treat symptomatically, treat underlying cause, prevent re-occurrence
3) appropriate referral
- use other people from sports medicine team (physician, massage therapist, chiropractor, etc.)
88
what are the 5 key points of the sideline assessment and management?
1) systematic: follows a system so that nothing is missed
2) sequential
- rule out one aspect of function before another
- avoid causing undo pain which may mask the real problem
3) complete
- be aware of multiple injuries and or contributing or possible causative factors (i.e. non MSK factors)
4) process of elimination
- find out what is not wrong, will lead to what is wrong
5) avoid assumptions
- may cause you to miss other injuries or conditions masquerading as MSK injury
89
sideline assessment and management: history
- more detailed than on field assessment
- provides reason - pain and dysfunction
- provides clues as to which structures may be damaged and how severe they are damaged
- rule out other conditions/diseases
- establish you indices of suspicion (IOS)
-general health history
-past/related injuries
-present injury
(MOI/PQRST)
90
sideline assessment and management: observation
- should begin with your first contact with the patient
- body language
- body symmetry or appearances
- motor function - posture and gait
- obvious signs (swelling , deformity, bruising, redness, scars)
- inspection
91
sideline assessment and management: examination
- develop routine to be methodical and thorough
- compare both sides of limb/joint
- use uninjured side as control
- rule out joints above and below (kinetic chain)
- reproduce symptoms through movement (AROM) and (PROM)
- assess local tissues around injury for pain/tenderness, swelling, spasms, increased tonicity
- assess referred pain to and from injury site
92
sideline assessment and management: active ROM
- assess individual's willingness to move, pain free ROM and muscle power
- "functional range"
- assesses damage to contractile and non-contractile tissues
- movements done by the individual
93
sideline assessment and management: PROM
- assess limitations in ROM, especially the sensation at the endpoint
- assesses damage to joint and surrounding structures (non-contractile tissues)
- position patient so that muscles are relaxed
- movements done by the examiner with gentle over-pressure
94
what are the 4 normal end feels?
1) soft tissue approximation
- soft and spongy, gradual stop
- ex: knee flexion
2) capsular feel
- firm end point with little give
- ex: hip rotation
3) bone-to-bone
- distinct, abrupt stop
- ex: elbow extension
4) muscular
- springy feel with some discomfort
- ex: shoulder abduction
95
what are the 4 abnormal end feels
1) empty feel
- move beyond anatomical limits with pain
- ex: 3rd degree ligament rupture
2) spasm
- involuntary muscle contraction
- guarding (back spasm)
3) loose
- extreme hyper-mobility
- ex: previous ankle sprain
4) springy block
- rebound at end point
- ex: meniscus pain
96
sideline assessment: isometric resisted muscle testing
- assesses individual's strength - hold 5-6 seconds (weakness takes time to develop)
- assesses damage to contractile tissues (muscle and tendons) - position to isolate a muscle/muscle group
- rated according to a 0-5 scale
97
sideline assessment: special tests
-determines presence of a particular type of disease, condition, or injury
98
sideline assessment: palpation
helps to differentiate between injured and non-injured structures
assess for:
-tissue resistance (texture and quality), muscle tone, trigger points, deformity, swelling, tenderness
- carried out systematically and usually done LAST in the assessment
- start with light pressure, gradually deeper
- begin away from injury site, gradually move distal to proximal
- serves to re-affirm findings
99
when palpating the injury site during the sideline assessment, what should you be looking for?
- skin temperature
- pulses
- swelling
- crepitus
- spasms
- point tenderness
- deformity
100
sideline assessment: functional testing
Begin with simple functional movements
-walking, running (in line or with cutting), tep downs (eccentric), squat or lunge, hops or jumps, push up
-individual must be able to perform all required sport movement and/or activities with full ROM, strength, power, speed, and reactivity in order to continue or be fully RTP
101
sideline assessment: sideline care and instructions
1) home care advise/instruction
- POLICE - protect, optimal loading, ice, compression, elevation
- give detailed, specific instructions
2) further stabilization
- taping, wrapping, splinting, crutches, etc.
3) vital sign check before release
4) referral for further care
- urgent care, physician,, therapist
102
MSK assessment: document injury evaluation
1) injury report form
- follow policies and procedures
- identify any equipment or procedures that require modification
- important in legal liability cases
-SOAP notes
103
what are SOAP notes?
- complete, accurate documentation of the evaluation
- important for insurance billing and continuation of care
- abbreviations can decrease time to complete
-subjective (injury history and symptoms), objective (findings of observation, palpation, physical evaluation), assessment (professional judgement of anatomical structure involved and severity - only physicians), plan (treatment/management - 1st aid, POLICE, therapy, education, appropriate referral, short and long term goals)
104
review summary on non-urgent injury assessment
slides for week 3
105
having a firm understanding of the _____ is vital in order to safely and effectively develop a treatment or management plan
injury cycle and healing stages
106
what is the ultimate goal in terms of rehabilitation medicine?
Create an environment that is conducive to the healing process
- not much can be done to speed up the process
- many things may be done to impede healing
107
trauma - def
physical injury or wound that is produced by an external or internal force
108
give an example of an external force that could cause trauma
- any physical contact
| - ex: tackle, slash, hit, etc.
109
give an example of an internal force that could cause trauma
- stress and strain from the body
- position or movement being done by the individual
- ex: ACL injuries are often non-contact
110
what is the strain-stress curve?
a tissue can go through three phases: elastic, plastic, failure
- a tissue has elastic properties and when stretched, will go back to its original position, until it is stretched past the yield point, where it will now begin to exhibit plastic changes
- this means that there is permanent damage and the tissue will no longer go back to its original shape
- at the end of this phase, there is tissue failure/injury
111
compression - def
- shortens and widens a structure
| - ex: arthritic changes in cartilage, fractures, contusions
112
tension - def
- pulls or stretches tissue
| - ex: muscle strains and ligament sprains
113
what are the 5 types of tissue loading that produce stress and strain
1) compression
2) tension
3) shearing
4) bending
5) torsion
114
shearing - def
- equal but not directly opposite loads are applied to opposing surfaces, forcing those surfaces to move in parallel directions
- ex: skin injuries such as blisters or abrasions; vertebral disc injuries
115
bending - def
- original axis is maintained while convex side lengthens and concave side is shortened
- usually seen in longer lever systems
- ex: fractures to long bones
116
torsion - def
- twisting in opposite directions from the opposite ends of a structure
- ex: spiral fracture in a long bone
117
acute injury - def
traumatic even initiates the injury process
| -one time force causes the injury - higher magnitude force for a shorter duration
118
chronic injury - def
- if an acute injury doesn't heal properly
- overuse (repetitive or recurrent)
- insidious onset - patient often doesn't "know" how it happened, because it didn't happen at an exact time - build up over time
119
what are examples of muscle injuries that are acute? chronic?
acute: strain, contusion
chronic: cramp, soreness, tendinitis/tendinosis, tenosynovitis
120
what are examples of synovial joint injuries that are acute? chronic?
acute: dislocation, subluxation, ligament sprain
chronic: osteoarthritis, capsulitis/synovitis
121
what are examples of injuries to bone that are acute? chronic?
acute: fracture, contusion
chronic: stress fracture, periositis
122
what are examples of injuries to nerves that are acute? chronic?
acute: neuropraxia
chronic: neuritis
123
what are examples of injuries to skin that are acute? chronic?
acute: abrasions, lacerations, punctures
chronic: blisters
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what are the three phases to the healing process?
1) inflammatory phase
2) fibroblastic repair phase
3) maturation-remodeling phase
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each phase in the healing process of an injury happen individually
true or false?
false, the phases overlap each other
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phase 1 of healing process: inflammatory response phase
-cellular injury release blood and fluids (exudate) - cell dealth, blood vessels break,etc.
- chemical mediators are liberates:
- histamine, leukotriens and prostoglandins/cytokines
- important in limiting exudate accumulation (swelling)
- vascular reaction:
- vasoconstriction (leading away from injury site) to limit bleeding
- vasodilation to bring blood and blood products to form a clot
- platelets and leukocytes adhere to collagen fibres
- form a fibrin plug
- obstruct local lymphatic drainage and localize the injury response
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how long is the inflammatory response phase?
-2-4 days after injury (short window)
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what are the signs and symptoms of the inflammatory response phase?
SHARP
| -swelling, heat, altered function, redness, pain
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phase 2 of the injury healing process: fibroblastic repair phase
- scar tissue formation (fibroplasia) and repair of injured tissue
- inflammatory signs and symptoms subside
- caution patients to use pain as a guide and not do too much activity
- endothelial capillary buds growth improves blood supply
- brings essential nutrients to area, trying to build up collagen that's been lost
-fibrin clot replaced by granulation tissue (fibroblasts, capillaries, collagen (type 3)) (day 3-5)
- fibroblastic cells continue to deposit more collagen in a random pattern (day 6-7) - type 3 collagen is weak and fragile, poorly organized
- as collagen synthesizes, fibroblasts diminish - increased tensile strength (more collagen, less fibroblasts)
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how long is the fibroblastic repair phase?
can last days to weeks
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phase 3 of injury healing process: maturation-remodeling phase
- trying to get scar tissue to mimic original tissue as much as possible
- long term process (weeks to years)
- maturation and realignment of scar tissue
- type I collagen replaces type 3
- collagen fibers realign parallel to the applied line of tension
- scar tissue gradually assumes normal appearance and function, but never the same as uninjured tissue
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Wolff's Law
- states that bone in a healthy person or animal will adapt to the loads under which it is placed.
- progressive increases in loads through rehabilitation is critical
- controlled mobilization throughout healing process - pain, swelling, or other clinical symptoms dictates progression
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what type of controlled mobilization should be utilized during each phase of the healing process?
inflammatory: immobilization recommended
fibroblastic repair phase: controlled activity of flexibility or strength
maturation remodelling: aggressive AROM and strengthening
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what are 4 ways in which we can classify MSK injuries?
1) MOI and duration of symptom onset (i.e. acute vs chronic)
2) location and body part (i.e. bone, cartilage, ligaments, tendons, muscles, joint bursae, nerve, skin)
3) type (i.e. fracture, sprains, strains, contusions, dislocations, subluxations)
4) severity (i.e. grades or degrees of damage to structures)
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what is one of the most common injuries encountered in sport?
muscle strain
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which are 3 muscles that are most susceptible to strain? why?
hamstring, quadriceps, and achilles tendon
- these muscles are subject to high tension forces, and their origin and insertion passes over two joints
- concentric and eccentric actions of the same muscle over different joints
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grade 1 muscle strain
some fibers stretched or torn; tenderness and pain on active motion; movement is painful, but FROM possible
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grade 2 muscle strain
several fibers are torn; active contraction extremely painful; depression or divot may be palpable; delayed bleeding causes hematoma and ecchymosis; ROM limited by pain
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grade 3 muscle strain
complete rupture of all fibers (including nerves); significant impairment and loss of movement; painful initially, but quickly diminishes
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who is most prone to achilles tendon strains?
runners and typically unfit individuals (older)
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what are 6 predisposing factors leading to muscle strains?
1) inadequate dynamic warm ups
2) insufficient joint ROM
3) excessive muscular tightness
4) fatigue, overuse or inadequate recovery from previous injury
5) muscular imbalances (protagonist vs antagonist muscles)
6) prior muscular or tendon injuries
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how do we treat a muscle strain?
- RICES, PRICE, or POLICE
- limit ROM, stabilize, and protect
- gentle mobilization (within pain-free ROM) - avoid aggressive stretching
- gentle early massage but NOT within the first 24-48 hours
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why is it bad to massage a muscle strain within the first 24-48 hours?
massaging increases blood flow to the area, and in the first couple days the injury is still in the inflammatory phase, so you want to limit inflammation, not promote it
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what is muscle contusion
- blow from external object causes soft tissue to compress against underlying bone
- localized bleeding (ecchymosis) in the tissues
- quads and biceps are vulnerable
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what are the signs and symptoms of a muscle contusion?
- history of a blow
- weakness and pain
- tightness or swelling
- limited ROM
- palpable hematoma, or lump, in the muscle tissue
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how can we treat a muscle strain?
Immediately:
- POLICE
- ice the area while muscle is lightly stretched
- compression with padding and elastic wrap
- use crutches if unable to walk without pain or limp
- rest from activities - 3 days
- avoid heat and massage (promotes additional inflammation)
follow up:
- mild stretching two to three times per day
- begin light activity like jogging, swimming, or stationary cycling
- increase activity each day if no pain is present
- ice 15 to 20 minutes after activities
- protect upon RTP - avoid repetitive force, could lead to secondary injury
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what could happen if a muscle contusion is repeatedly subject to additional forces?
Myositis Ossificans
- calcification of a bruise inside a muscle
- complication of severe or repeated contusions
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how can we prevent myositis ossificans?
rest and protect the injured area
- the hematoma fromt he severe contusion area can calcify (heterotopic ossification)
- detected via X-ray or MRI
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joint subluxation
- partial separation of the joint
| - may or may not immediately go back in place
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where are joint subluxations common?
-ribs, fingers, and patella for females
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why are subluxations of the patella more common in females?
- when the patella dislocates or subluxes, typically goes lateral
- anatomically, medial epicondyle of femur is bigger
- females tend to have wider hips which affects the Q angle
- contracting quads leads to more lateral shift in the patella
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joint dislocation
- complete disruption of the articulating surfaces of a joint
- deformity present, although may be obscured by heavy musculature - palpation and comparison to healthy side is important
- pain can vary from minimal to extreme
-chronic dislocations are more likely to pop back in
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what are the most common areas of joint dislocation?
shoulder, elbow, and fingers
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how do we treat a dislocated joint?
- splint and support the joint
- should NOT be reduced immediately
- requires X-ray to rule out possible fractures, ESPECIALLY for first time dislocation
- often requires manual or surgical relocation - after repeated dislocations, patient may be able to relocate easily
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what are some possible complications with joint injuries other than fractures?
- nerve damage
- vascular damage
- articular damage
- labral or meniscus damage
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ligament sprain
- ligaments provide passive joint stability
- injury occurs when forces are transmitted from the bone to the ligament and the ligament fails under the excessive load
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when ligaments are damaged, what do we rely on to provide joint stability?
- there are three level of protection for joint stability - musculature, ligaments, cartilage and body alignment
- rely on muscles when a ligament is sprained
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grade 1 ligament sprain
some stretching of fibers; minimal joint instability; mild to moderate pain; localized swelling and joint stiffness
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grade 2 ligament sprain
some tearing and separation of fibers; moderate joint instability; moderate to severe pain, swelling, and stiffness
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grade 3 ligament sprain
complete tearing of ligament; severe joint instability )possible subluxation); painful initially, then no pain; severe joint swelling and stiffness
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how is the healing process in a ligament sprain?
- healing is slow due to poor blood supply
- very painful due to good nerve supply (for grade 1 and 2, in grade 3, everything is ruptured)
- restoring joint stability is difficult, as ligaments are lengthened (stress/strain curve)
- surrounding musculature requires strengthening
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how can we treat a ligament sprain?
grade 1 and 2:
- first aid management (POLICE)
- electro-therapeutic modalities, joint mobilization, soft tissue massage
- muscle strengthening, proprioceptive training, functional training
grade 3:
-surgery repair/reconstruction or protective bracing instead of -electro-therapeutic modalities, joint mobilization, soft tissue massage
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closed bone fracture
little or no displacement of broken bones
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open bone fracture
fractured end pierces the surrounding tissue, including skin
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how do we classify bone fractures?
by fracture pattern, location, displacement type
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what are the 7 types of fractures?
1) transverse
2) linear
3) oblique, non-displaced
4) oblique, displaced
5) spiral
6) greenstick
7) comminuted
(look at pictures)
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what are three common fractures?
1) Colles' Fracture
2) boxer's fracture
3) calcaneal avulsion fracture
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look at epiphyseal fractures
set of slides #4
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what are the signs and symptoms of bone fractures?
- pain
- tenderness
- localized bruising
- localized swelling
- possible deformity
- altered function or restricted ability to move
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what are 5 different fracture tests we can do?
- tap
- compression
- squeeze
- bump
- tuning fork (not really used)
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how can we manage bone fractures?
- splinting and slinging
- bracing and/or casting
- if displaced - reduction (realignment) and immobilization
- if displaced and unstable - surgical fixation (ORIF - open reduction and internal/rigid fixation)
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what are some possible complication that could result from a bone fracture?
- infection - higher chance of infection in open fractures
- acute compartment syndromes (excessive blood or swelling will fill fascia and can compress on important nerves or arteries in the area)
- associated injury to skin, blood vessels, nerves, etc.
- deep vein thrombosis (aka DVT)/ pulmonary embolism
- delayed union or mal-union (some bones heal well and some don't)
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what is the MOI of a bone contusion?
direct blow to a bony prominence
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what are the signs and symptoms of a bone contusion?
hematoma, pain, weakness in surrounding musculature
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how can we treat a bone contusion?
rest, NSAIDs, therapy that focuses on stretching
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what are the signs and symptoms of acute compartment syndrome
- anterior and deep posterior compartments are most susceptible
- deep, aching pain
- tightness and swelling in affected compartment
- reduced circulation and sensory changes
- red, shiny skin
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how can we treat acute compartment syndrome?
Conservative:
- rest, ice, and elevation
- compression is contraindicated - already a build up of pressure in the area
Emergency fasciotomy in worst cases
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nerve injury: nerve stretch
- sharp or burning pain radiating down a limb
| - muscle weakness - burning or numbness
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nerve injury: neuropraxia
- compression or mild, blunt blow close to the nerve
- temporary loss of function - motor affected more than sensory, b ut people often notice a burning sensation
- reversible in hours to months (average 6-8 weeks)
- nerve fiber can regenerate (cell body cannot) - only if the peripheral aspect is damaged
- nerve regeneration is very slow (3-4 mm per day)
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nerve injury: stinger/burner
- common in football/rugby
- when the neck gets stretched to the side and brachial plexus is compressed
- hand goes numb - can be temporary
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skin injuries: abrasions
- superficial damage (no deeper than epidermis)
- typically from a fall or contact
- treatment: clean and cover
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skin injuries: lacerations
- tearing of soft body tissue
- irregular and jagged edges
- treatment: may require stitches
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skin injuries: punctures
- deep due to something sharp and pointed
- opening on the skin is small
- easily infected
